Healthcare Provider Details

I. General information

NPI: 1356077721
Provider Name (Legal Business Name): MATTHEW PROKEY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4980 N MAIN ST APT 126
FALL RIVER MA
02720-2012
US

IV. Provider business mailing address

4980 N MAIN ST APT 126
FALL RIVER MA
02720-2012
US

V. Phone/Fax

Practice location:
  • Phone: 207-251-6676
  • Fax:
Mailing address:
  • Phone: 207-251-6676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: